The present invention provides methods and kits for treating osteoarthritis using an estrogen agonist/antagonist.

Images(17)

Claims(8)

What is claimed is:

1. A method of treating osteoarthritis, the method comprising administering to a patient having or at risk of having osteoarthritis, a therapeutically effective amount of an estrogen agonist/antagonist of formula (I):

(e) a five membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

(f) a six membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n— optionally substituted with 1-3 substituents independently selected from R4; or

(g) a bicyclic ring system consisting of a five or six membered heterocyclic ring fused to a phenyl ring, said heterocyclic ring containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

Z1 is

(a) —(CH2)pW(CH2)q—;

(b) —O(CH2)pCR5R6—;

(c) —O(CH2)pW(CH2)q—;

(d) —OCHR2CHR3; or

(e) —SCHR2CHR3—;

G is

(a) —NR7R8;

(b)

wherein n is 0, 1 or 2; m is 1, 2 or 3; Z2 is —NH—, —O—, —S—, or —CH2—; optionally fused on adjacent carbon atoms with one or two phenyl rings and, optionally independently substituted on carbon with one to three substituents and, optionally, independently on nitrogen with a chemically suitable substituent selected from R4; or

(c) a bicyclic amine containing five to twelve carbon atoms, either bridged or fused and optionally substituted with 1-3 substituents independently selected from R4; or

Z1 and G in combination may be

W is

(a) —CH2—;

(b) —CH═CH—;

(c) —O—;

(d) —NR2—;

(e) —S(O)n—;

(f)

(g) —CR2(OH)—;

(h) —CONR2—;

(i) —NR2CO—;

(j)

(k) —C≡C—;

R is hydrogen or C1-C6 alkyl;

R2 and R3 are independently

(a) hydrogen; or

(b) C1-C4 alkyl;

R4 is

(a) hydrogen;

(b) halogen;

(c) C1-C6 alkyl;

(d) C1-C4 alkoxy;

(e) C1-C4 acyloxy;

(f) C1-C4 alkylthio;

(g) C1-C4 alkylsulfinyl;

(h) C1-C4 alkylsulfonyl;

(i) hydroxy (C1-C4)alkyl;

(j) aryl (C1-C4)alkyl;

(k) —CO2H;

(l) —CN;

(m) —CONHOR;

(n) —SO2NHR;

(o) —NH2;

(p) C1-C4 alkylamino;

(q) C1-C4 dialkylamino;

(r) —NHSO2R;

(s) —NO2;

(t) -aryl; or

(u) —OH;

R5 and R6 are independently C1-C8 alkyl or together form a C3-C10 carbocyclic ring;

R7 and R8 are independently

(a) phenyl;

(b) a C3-C10 carbocyclic ring, saturated or unsaturated;

(c) a C3-C10 heterocyclic ring containing up to two heteroatoms, selected from —O—, —N— and —S—;

(d) H;

(e) C1-C6 alkyl; or

(f) form a 3 to 8 membered nitrogen containing ring with R5 or R6;

R7 and R8 in either linear or ring form may optionally be substituted with up to three substituents independently selected from C1-C6 alkyl, halogen, alkoxy, hydroxy and carboxy;

a ring formed by R7 and R8 may be optionally fused to a phenyl ring;

e is 0, 1 or 2;

m is 1, 2 or 3;

n is 0, 1 or 2;

p is 0, 1, 2 or 3;

q is 0, 1, 2 or 3;

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, or quaternary ammonium salt thereof.

2. The method of claim 1 wherein the estrogen agonist/antagonist is a compound of formula (IA)

wherein G is

R4 is H, OH, F, or Cl; and B and E are CH or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, or quaternary ammonium salt thereof.

3. The method of claim 1 wherein the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, or quaternary ammonium salt thereof.

5. A method of treating osteoarthritis, the method comprising the step of administering to a patient having or at risk of having osteoarthritis, an estrogen agonist/antagonist of formula (1) of claim 1 and a COX-2 inhibitor.

6. The method of claim 5 wherein the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, or quaternary ammonium salt thereof, and the COX-2 inhibitor is celecoxib or rofecoxib.

7. The method of claim 6 wherein the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl- ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol, D-tartrate salt and the COX-2 inhibitor is celecoxib or rofecoxib.

This invention relates to methods and kits for treating osteoarthritis using an estrogen agonist/antagonist.

BACKGROUND OF THE INVENTION

Osteoarthritis is the most common joint disorder and is characterized by loss of joint cartilage and hypertrophy of bone at the joint. This disorder usually begins asymtomatically in the 2nd to 3rd decade of life and is very common by age seventy. Almost all persons by age forty have some pathological change in weight-bearing joints. Men and women are equally affected, but onset is earlier in men.

Joint cartilage, also called hyaline cartilage, is made up of 95% water and extracellular matrix and 5% chondrocytes. The extracellular matrix comprises proteoglycans and Type II collagen.

Osteoarthritis is a progressive disease. Typical symptomatic treatment includes the management of pain that accompanies osteoarthritis and changes in lifestyle such as diet and exercise. Examples of compounds that have been used to treat the pain associated with osteoarthritis include acetominophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, ketoprofen, nabumetone, etodolac, salsalate, sulindac, diclofenac, tolmetin, flurbiprofen, piroxicam, fenoprofen, indomethacin, meclofenamate, oxaprozin, diflunisal, and ketorolac; and selective cyclooxygenase-2 (COX-2) inhibitors such as Celebrex® and Vioxx®. Because NSAIDs can have unwanted side effects such as ulcers, NSAIDs are sometimes administered with other compounds that ameliorate the side effects of the NSAIDs. Typical compounds that are used in combination with NSAIDs include proton pump inhibitors such as omeprazole; antacids such as sucralfate; and H2 blockers such as ranitidine, cimetidine, famotidine, and nizatidine. In addition, products derived from natural substances have been used to treat osteoarthritis. Examples of natural substances include hyaluronic acid, glucosamine, chondroitin sulfate, and capsaicin. Intraarticular corticosteriods have also been used to treat osteoarthritis. Presently, there are no widely accepted treatments that reduce the progression of cartilage damage in osteoarthritis.

It has been found that chondrocytes, which are a main component of cartilage and produce proteoglycans and Type II collagen, contain estrogen receptors. The present invention provides methods for preventing or reducing the rate of cartilage degradation using an estrogen receptor agonist/antagonist.

SUMMARY OF THE INVENTION

The present invention provides methods of treating osteoarthritis, the methods comprising administering to a patient having or at risk of having osteoarthritis, a therapeutically effective amount of an estrogen agonist/antagonist of formula (I):

(e) a five membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

(f) a six membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n— optionally substituted with 1-3 substituents independently selected from R4; or

(g) a bicyclic ring system consisting of a five or six membered heterocyclic ring fused to a phenyl ring, said heterocyclic ring containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

Z1 is

(a) —(CH2)pW(CH2)q—;

(b) —O(CH2)pCR5R6—;

(c) —O(CH2)pW(CH2)q—;

(d) —OCHR2CHR3—; or

(e) —SCHR2CHR3—;

G is

(a) —NR7R8;

(b)

wherein n is 0, 1 or 2; m is 1, 2 or 3; Z2 is —NH—, —O—, —S—, or —CH2—; optionally fused on adjacent carbon atoms with one or two phenyl rings and, optionally independently substituted on carbon with one to three substituents and, optionally, independently on nitrogen with a chemically suitable substituent selected from R4; or

(c) a bicyclic amine containing five to twelve carbon atoms, either bridged or fused and optionally substituted with 1-3 substituents independently selected from R4; or

Z1 and G in combination may be

W is

(a) —CH2—;

(b) —CH═CH—;

(c) —O—;

(d) —NR2—;

(e) —S(O)n—;

(f)

(g) —CR2(OH)—;

(h) —CONR2—;

(i) —NR2CO—;

(j)

(k) —C≡C—;

R is hydrogen or C1-C6 alkyl;

R2 and R3 are independently

(a) hydrogen; or

(b) C1-C4 alkyl;

R4 is

(a) hydrogen;

(b) halogen;

(c) C1-C6 alkyl;

(d) C1-C4 alkoxy;

(e) C1-C4 acyloxy;

(f) C1-C4 alkylthio;

(g) C1-C4 alkylsulfinyl;

(h) C1-C4 alkylsulfonyl;

(i) hydroxy (C1-C4)alkyl;

(j) aryl (C1-C4)alkyl;

(k) —CO2H;

(i) —CN;

(m) —CONHOR;

(n) —SO2NHR;

(o) —NH2;

(p) C1-C4 alkylamino;

(q) C1-C4 dialkylamino;

(r) —NHSO2R;

(s) —NO2;

(t) -aryl; or

(u) —OH;

R5 and R6 are independently C1-C8 alkyl or together form a C3-C10 carbocyclic ring;

R7 and R8 are independently

(a) phenyl;

(b) a C3-C10 carbocyclic ring, saturated or unsaturated;

(c) a C3-C10 heterocyclic ring containing up to two heteroatoms, selected from —O—, —N— and —S—;

(d) H;

(e) C1-C6 alkyl; or

(f) form a 3 to 8 membered nitrogen containing ring with R5 or R6;

R7 and R8 in either linear or ring form may optionally be substituted with up to three substituents independently selected from C1-C6 alkyl, halogen, alkoxy, hydroxy and carboxy;

a ring formed by R7 and R8 may be optionally fused to a phenyl ring;

e is 0, 1 or 2;

m is 1, 2 or 3;

n is 0, 1 or 2;

p is 0, 1, 2 or 3;

q is 0, 1, 2 or 3;

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof.

In a preferred embodiment of the methods, the estrogen agonist/antagonist is a compound of formula (IA)

wherein G is

R4 is H, OH, F, or Cl; and B and E are independently selected from CH and N or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof.

In a preferred embodiment of the methods, the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof.

In another preferred embodiment of the methods, the estrogen agonist/antagonist is in the form of a D-tartrate salt.

In another preferred embodiment of the methods, the estrogen agonist/antagonist is selected from the group consisting of tamoxifen, 4-hydroxy tamoxifen, droloxifene, toremifene, centchroman, idoxifene, 6-(4-hydroxy-phenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-benzyl]-naphthalen-2-ol, {4-[2-(2-aza-bicyclo[2.2.1]hept-2-yl)-ethoxy]-phenyl}-[6-hydroxy-2-(4-hydroxy-phenyl)-benzo[b]thiophen-3-yl]-methanone, EM-652, EM-800, GW 5638, GW 7604, and optical or geometric isomers thereof; and pharmaceutically acceptable salts, N-oxides, esters, quaternary ammonium salts, and prodrugs thereof. In addition, raloxifene can be used to prevent or reduce the rate of cartilage degradation.

Also provided are methods of treating osteoarthritis, the methods comprising administering to a patient having or at risk of having osteoarthritis, a therapeutically effective amount of an estrogen agonist/antagonist of formula V or VI:

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof.

In a preferred embodiment of the methods, the estrogen agonist/antagonist is the compound TSE-424 of formula Va below:

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof.

Also provided are methods of treating osteoarthritis, the methods comprising administering to a patient having or at risk of having osteoarthritis, a therapeutically effective amount of an estrogen agonist/antagonist of formula IlIl (EM-652) below or formula IV (EM-800) below:

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof.

The present invention provides kits for use by a consumer to treat osteoarthritis, the kits comprising:

(e) a five membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

(f) a six membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n— optionally substituted with 1-3 substituents independently selected from R4; or

(g) a bicyclic ring system consisting of a five or six membered heterocyclic ring fused to a phenyl ring, said heterocyclic ring containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

Z1 is

(a) —(CH2)pW(CH2)q—;

(b) —O(CH2)pCR5R6—;

(c) —O(CH2)pW(CH2)q—;

(d) —OCHR2CHR3; or

(e) —SCHR2CHR3—;

G is

(a) —NR7R8;

(b)

wherein n is 0, 1 or 2; m is 1, 2 or 3; Z2 is —NH—, —O—, —S—, or —CH2—; optionally fused on adjacent carbon atoms with one or two phenyl rings and, optionally independently substituted on carbon with one to three substituents and, optionally, independently on nitrogen with a chemically suitable substituent selected from R4; or

(c) a bicyclic amine containing five to twelve carbon atoms, either bridged or fused and optionally substituted with 1-3 substituents independently selected from R4; or

Z1 and G in combination may be

W is

(a) —CH2—;

(b) —CH═CH—;

(c) —O—;

(d) —NR2—;

(e) —S(O)n—;

(f)

(g) —CR2(OH)—;

(h) —CONR2—;

(i) —NR2CO—;

(j)

(k) —C≡C—;

R is hydrogen or C1-C6 alkyl;

R2 and R3 are independently

(a) hydrogen; or

(b) C1-C4 alkyl;

R4 is

(a) hydrogen;

(b) halogen;

(c) C1-C6 alkyl;

(d) C1-C4 alkoxy;

(e) C1-C4 acyloxy;

(f) C1-C4 alkylthio;

(g) C1-C4 alkylsulfinyl;

(h) C1-C4 alkylsulfonyl;

(i) hydroxy (C1-C4)alkyl;

(j) aryl (C1-C4)alkyl;

(k) —CO2H;

(l) —CN;

(m) —CONHOR;

(n) —SO2NHR;

(o) —NH2;

(p) C1-C4 alkylamino;

(q) C1-C4 dialkylamino;

(r) —NHSO2R;

(s) —NO2;

(t) -aryl; or

(u) —OH;

R5 and R6 are independently C1-C8 alkyl or together form a C3-C10 carbocyclic ring;

R7 and R8 are independently

(a) phenyl;

(b) a C3-C10 carbocyclic ring, saturated or unsaturated;

(c) a C3-C10 heterocyclic ring containing up to two heteroatoms, selected from —O—, —N— and —S—;

(d) H;

(e) C1-C6 alkyl; or

(f) form a 3 to 8 membered nitrogen containing ring with R5 or R6;

R7 and R8 in either linear or ring form may optionally be substituted with up to three substituents independently selected from C1-C6 alkyl, halogen, alkoxy, hydroxy and carboxy;

a ring formed by R7 and R8 may be optionally fused to a phenyl ring;

e is 0, 1 or 2;

m is 1, 2 or 3;

n is 0, 1 or 2;

p is 0, 1, 2 or 3;

q is 0, 1, 2 or 3;

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof, and a pharmaceutically acceptable carrier, vehicle or diluent; and

(b) instructions describing a method of using the pharmaceutical composition to treat osteoarthritis.

In a preferred embodiment of the kits, the estrogen agonist/antagonist is a compound of formula (IA):

wherein G is

R4 is H, OH, F, or Cl; and B and E are independently selected from CH and N or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof.

In another preferred embodiment of the kits, the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof.

In another preferred embodiment of the kits, the (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol is in the form of a D-tartrate salt.

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof, and a pharmaceutically acceptable carrier, vehicle or diluent; and

(b) instructions describing a method of using the pharmaceutical composition to treat osteoarthritis.

Also provided are kits for use by a consumer to treat osteoarthritis, the kits comprising:

or an optical or geometric isomer thereof; or a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt or prodrug thereof, and a pharmaceutically acceptable carrier, vehicle or diluent; and

(b) instructions describing a method of using the pharmaceutical composition to treat osteoarthritis.

In a preferred embodiment of the kits, the kits further comprise an additional compound that is useful to treat osteoarthritis arthritis.

In a preferred embodiment of the kits with an additional compound, the additional compound is a nonsteroidal anti-inflammatory drug.

In a preferred embodiment of the kits with an additional compound, the additional compound is a COX-2 inhibitor.

In a preferred embodiment of the kits with an additional compound, the additional compound is a COX-2 inhibitor and the COX-2 inhibitor is Celebrex® or Vioxx®.

Also provided are kits for use by a consumer to treat osteoarthritis, the kits comprising:

(a) an estrogen agonist/antagonist;

(b) a COX-2 inhibitor;

(c) instructions describing a method of using the estrogen agonist/antagonist and COX-2 inhibitors to treat osteoarthritis; and

(d) a container for the estrogen agonist/antagonist, COX-2 inhibitor, and instructions.

In a preferred embodiment of the kits, the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof, and the COX-2 inhibitor is Celebrex® or Vioxx®.

Also provided are methods of treating osteoarthritis, the method comprising the step of administering to a patient having or at risk of having osteoarthritis, an estrogen agonist/antagonist and a COX-2 inhibitor.

In a preferred embodiment of the methods, the estrogen agonist/antagonist is (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof, and the COX-2 inhibitor is Celebrex® or Vioxx®.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to methods of treating osteoarthritis, the methods comprising administering to a patient having or at risk of having osteoarthritis a therapeutically effective amount of an estrogen agonist/antagonist. Estrogen agonists/antagonists are also called selective estrogen receptor modulators (SERMs).

The following terms are defined below:

The terms “treat”, “treatment”, and “treating” include preventative (e.g., prophylactic) and palliative treatment or the act of providing preventative or palliative treatment. In the present invention, these terms include the amelioration of one or more symptoms of osteoarthritis and/or the prevention of cartilage damage or the reduction in the rate of cartilage damage.

An “estrogen agonist/antagonist” is a compound that affects some of the same receptors that estrogen does, but not all, and in some instances, it antagonizes or blocks estrogen. It is also known as a “selective estrogen receptor modulator” (SERM). Estrogen agonists/antagonists may also be referred to as antiestrogens although they have some estrogenic activity at some estrogen receptors. Estrogen agonists/antagonists are therefore not what are commonly referred to as “pure antiestrogens”. Antiestrogens that can also act as agonists are referred to as Type I antiestrogens. Type I antiestrogens activate the estrogen receptor to bind tightly in the nucleus for a prolonged time but with impaired receptor replenishment (Clark, et al., Steroids 1973;22:707, Capony et al., Mol Cell Endocrinol, 1975; 3:233).

The estrogen agonists/antagonists of the invention may be administered systemically or locally. For systemic use, the estrogen agonists and antagonists herein are formulated for parenteral (e.g., intravenous, subcutaneous, intramuscular, intraperitoneal, intranasal or transdermal) or enteral (e.g., oral or rectal) delivery according to conventional methods. Intravenous administration can be by a series of injections or by continuous infusion over an extended period. Administration by injection or other routes of discretely spaced administration can be performed at intervals ranging from weekly to once to three or more times daily.

Preferred estrogen agonists/antagonists of the present invention include the compounds described in U.S. Pat. No. 5,552,412. Those compounds are described by the formula designated herein as formula (I) given below:

(e) a five membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

(f) a six membered heterocycle containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n— optionally substituted with 1-3 substituents independently selected from R4; or

(g) a bicyclic ring system consisting of a five or six membered heterocyclic ring fused to a phenyl ring, said heterocyclic ring containing up to two heteroatoms selected from the group consisting of —O—, —NR2— and —S(O)n—, optionally substituted with 1-3 substituents independently selected from R4;

Z1 is

(a) —(CH2)pW(CH2)q—;

(b) —O(CH2)pCR5R6—;

(c) —O(CH2)pW(CH2)q—;

(d) —OCHR2CHR3—; or

(e) —SCHR2CHR3—;

G is

(a) —NR7R8;

(b)

wherein n is 0, 1 or 2; m is 1, 2 or 3; Z2 is —NH—, —O—, —S—, or —CH2—; optionally fused on adjacent carbon atoms with one or two phenyl rings and, optionally independently substituted on carbon with one to three substituents and, optionally, independently on nitrogen with a chemically suitable substituent selected from R4; or

(c) a bicyclic amine containing five to twelve carbon atoms, either bridged or fused and optionally substituted with 1-3 substituents independently selected from R4; or

Z1 and G in combination may be

W is

(a) —CH2—;

(b) —CH═CH—;

(c) —O—;

(d) —NR2—;

(e) —S(O)n—;

(f)

(g) —CR2(OH)—;

(h) —CONR2—;

(i) —NR2CO—;

(j)

(k) —C≡C—;

R is hydrogen or C1-C6 alkyl;

R2 and R3 are independently

(a) hydrogen; or

(b) C1-C4 alkyl;

R4 is

(a) hydrogen;

(b) halogen;

(c) C1-C6 alkyl;

(d) C1-C4 alkoxy;

(e) C1-C4 acyloxy;

(f) C1-C4 alkylthio;

(g) C1-C4 alkylsulfinyl;

(h) C1-C4 alkylsulfonyl;

(i) hydroxy (C1-C4)alkyl;

(j) aryl (C1-C4)alkyl;

(k) —CO2H;

(l) —CN;

(m) —CONHOR;

(n) —SO2NHR;

(o) —NH2;

(p) C1-C4 alkylamino;

(q) C1-C4 dialkylamino;

(r) —NHSO2R;

(s) —NO2;

(t) -aryl; or

(u) —OH;

R5 and R6 are independently C1-C8 alkyl or together form a C3-C10 carbocyclic ring;

R7 and R8 are independently

(a) phenyl;

(b) a C3-C10 carbocyclic ring, saturated or unsaturated;

(c) a C3-C10 heterocyclic ring containing up to two heteroatoms, selected from —O—, —N— and —S—;

(d) H;

(e) C1-C6 alkyl; or

(f) form a 3 to 8 membered nitrogen containing ring with R5 or R6;

R7 and R8 in either linear or ring form may optionally be substituted with up to three substituents independently selected from C1-C6 alkyl, halogen, alkoxy, hydroxy and carboxy;

cis-6-(4-hydroxyphenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol; and

1-(4′-pyrrolidinoethoxyphenyl)-2-phenyl-6-hydroxy-1,2,3,4-tetrahydroisoquinoline and pharmaceutically acceptable salts thereof. An especially preferred salt of (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol is the D-tartrate salt.

Other preferred estrogen agonists/antagonists are disclosed in U.S. Pat. No. 5,047,431. The structure of these compounds are described by the formula designated herein as formula (II) below:

wherein

R1A and R2A may be the same or different and are either H, methyl, ethyl or a benzyl group; and optical or geometric isomers thereof; and pharmaceutically acceptable salts, N-oxides, esters, quaternary ammonium salts, and prodrugs thereof including droloxifene.

Additional preferred estrogen agonists/antagonists are tamoxifen: (ethanamine, 2-[-4-(1,2-diphenyl-1-butenyl)phenoxy]-N,N-dimethyl, (Z)-2-, 2-hydroxy-1,2,3-propanetricarboxylate(1:1)) and other compounds as disclosed in U.S. Pat. No. 4,536,516; 4-hydroxy tamoxifen (i.e., tamoxifen wherein the 2-phenyl moiety has a hydroxy group at the 4 position) and other compounds as disclosed in U.S. Pat. No. 4,623,660; raloxifene: (methanone, [6-hydroxy-2-(4-hydroxyphenyl)benzo[b]thien-3-yl][4-[2-(1-piperidinyl)ethoxy]phenyl]-,hydrochloride) and other compounds as disclosed in U.S. Pat. Nos. 4,418,068; 5,393,763; 5,457,117; 5,478,847 and 5,641,790; toremifene: (ethanamine,2-[4-(4-chloro-1,2-diphenyl-1-butenyl)phenoxy]-N,N-dimethyl-, (Z)—, 2-hydroxy-1,2,3-propanetricarboxylate (1:1) and other compounds as disclosed in U.S. Pat. Nos. 4,696,949 and 4,996,225; centchroman: 1-[2-[[4-(-methoxy-2,2,dimethyl-3-phenyl-chroman-4-yl)-phenoxy]-ethyl]-pyrrolidine and other compounds as disclosed in U.S. Pat. No. 3,822,287; idoxifene: pyrrolidine, 1-[-[4-[[1-(4-iodophenyl)-2-phenyl-1-butenyl]phenoxy]ethyl] and other compounds as disclosed in U.S. Pat. No. 4,839,155; 6-(4-hydroxy-phenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-benzyl]-naphthalen-2-ol and other compounds as disclosed in U.S. Pat. No. 5,484,795; and {4-[2-(2-aza-bicyclo[2.2.1]hept-2-yl)-ethoxy]-phenyl}-[6-hydroxy-2-(4-hydroxy-phenyl)-benzo[b]thiophen-3-yl]-methanone and other compounds as disclosed in published international patent application WO 95/10513. Other preferred compounds include GW 5638 and GW 7604. The synthesis of these compounds is described in Willson et al., J. Med. Chem., 1994;37:1550-1552.

Further preferred estrogen agonists/antagonists include EM-652 (as shown in the formula designated herein as formula (Ill) and EM-800 (as shown in the formula designated herein as formula (IV)). The synthesis of EM-652 and EM-800 and the activity of various enantiomers is described in Gauthier et al., J. Med. Chem., 1997;40:2117-2122.

Further preferred estrogen agonists/antagonists include TSE 424 and other compounds disclosed in U.S. Pat. Nos. 5,998,402, 5,985,910, 5,780,497, 5,880,137, and European Patent Application EP 0802183 A1 including the compounds described by the formulae designated herein as formulae V and VI, below:

wherein:

R1B is selected from H, OH or the C1-C12 esters (straight chain or branched) or C1-C12 (straight chain or branched or cyclic) alkyl ethers thereof, or halogens; or C1-C4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether.

The preferred compounds of this invention are those having the general structures V or VI, above, wherein:

R1B is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, and halogen;

R2B, R3B, R4B, R5B, and R6B are independently selected from H, OH or the C1-C12 esters or alkyl ethers thereof, halogen, cyano, C1-C6 alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when R1B is H, R2B is not OH;

R7B and R8B are selected independently from H, C1-C6 alkyl, or combined by —(CH2)w—, wherein w is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, C1-C4 alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy (C1-C4)alkyl, —CO2H, —CN, —CONH(C1-C4alkyl), —NH2, C1-C4 alkylamino, C1-C4 dialkylamino, —NHSO2(C1-C4alkyl), —CO(C1-C4alkyl), and —NO2; and optical and geometric isomers thereof; and nontoxic pharmacologically acceptable acid addition salts, N-oxides, esters, quaternary ammonium salts, and prodrugs thereof.

The rings formed by a concatenated R7B and R8B, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.

The most preferred compounds of structural formulas V and VI, above, are those wherein R1B is OH; R2B-R6B are as defined above; XA is selected from the group of Cl, NO2, CN, CF3, or CH3; YA is the moiety

and R7B and R8B are concatenated together as —(CH2)t—, wherein t is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, C1-C4 alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy (C1-C4)alkyl, —CO2H, —CN, —CONH(C1-C4)alkyl, —NH2, C1-C4 alkylamino, di(C1-C4)alkylamino, —NHSO2(C1-C4)alkyl, —NHCO(C1-C4)alkyl, and —NO2; and optical and geometric isomers thereof; and nontoxic pharmacologically acceptable acid addition salts, N-oxides, esters, quaternary ammonium salts, and prodrugs thereof.

Another preferred compound is TSE-424 as described by the formula designated herein as formula (Va) below:

The estrogen agonists/antagonists of this invention can be administered in the form of pharmaceutically acceptable salts. The salts are conveniently formed, as is usual in organic chemistry, by reacting the compound of this invention with a suitable acid. The salts are quickly formed in high yields at moderate temperatures, and often are prepared by merely isolating the compound from a suitable acidic wash as the final step of the synthesis. The salt-forming acid is dissolved in an appropriate organic solvent, or aqueous organic solvent, such as an alkanol, ketone or ester. On the other hand, if the compound of this invention is desired in the free base form, it is isolated from a basic final wash step, according to the usual practice. A preferred technique for preparing hydrochlorides is to dissolve the free base in a suitable solvent and dry the solution thoroughly, as over molecular sieves, before bubbling hydrogen chloride gas through it. A preferred salt of (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol is the D-(−)-tartrate salt. It will also be recognized that it is possible to administer amorphous forms of the estrogen agonists/antagonists.

One of ordinary skill in the art will recognize that certain estrogen agonists/antagonists of this invention will contain one or more atoms which may be in a particular stereochemical, tautomeric, or geometric configuration, giving rise to stereoisomers, tautomers and configurational isomers. All such tautomers and isomers and mixtures thereof are included in this invention. Hydrates and solvates of the compounds of this invention are also included.

The subject invention also includes isotopically-labeled estrogen agonists/antagonists, which are structurally identical to those disclosed above, but for the fact that one or more atoms are replaced by an atom having an atomic mass or mass number different from the atomic mass or mass number usually found in nature. Examples of isotopes that can be incorporated into compounds of the invention include isotopes of hydrogen, carbon, nitrogen, oxygen, phosphorous, sulfur, fluorine and chlorine, such as 2H, 3H, 13C, 14C, 15N, 18O, 17O, 31p, 32p, 35S, 18F and 36Cl, respectively. Compounds of the present invention, prodrugs thereof, and pharmaceutically acceptable salts of said compounds and of said prodrugs which contain the aforementioned isotopes and/or other isotopes of other atoms are within the scope of this invention. Certain isotopically labeled compounds of the present invention, for example those into which radioactive isotopes such as 3H and 14C are incorporated, are useful in drug and/or substrate tissue distribution assays. Tritiated, i.e., 3H, and carbon-14, i.e., 14C, isotopes are particularly preferred for their ease of preparation and detectability. Further, substitution with heavier isotopes such as deuterium, i.e., 2H, may afford certain therapeutic advantages resulting from greater metabolic stability, for example increased in vivo half-life or reduced dosage requirements and, hence, may be preferred in some circumstances. Isotopically labeled compounds of this invention and prodrugs thereof can generally be prepared by carrying out known or referenced procedures and by substituting a readily available isotopically labeled reagent for a non-isotopically labeled reagent.

Those of ordinary skill in the art will recognize that physiologically active compounds which have accessible hydroxy groups can be administered in the form of pharmaceutically acceptable esters. The compounds of this invention can be effectively administered as an ester, formed on the hydroxy groups, just as one skilled in pharmaceutical chemistry would expect. It is possible, as has long been known in pharmaceutical chemistry, to adjust the rate or duration of action of the compound by appropriate choices of ester groups.

Certain ester groups are preferred when a compound of this invention contains an ester. The estrogen agonists/antagonists including the compounds of formula I, IA, II, III, IV, V, Va, or VI may contain ester groups at various positions as defined herein above, where these groups are represented as —COOR9, R9 is C1-C14 alkyl, C1-C3 chloroalkyl, C1-C3 fluoroalkyl, C5-C7 cycloalkyl, phenyl, or phenyl mono- or disubstituted with C1-C4 alkyl, C1-C4 alkoxy, hydroxy, nitro, chloro, fluoro or tri(chloro or fluoro)methyl.

As used herein, the term “effective amount” means an amount of compound that is capable of treating a described pathological condition. An effective amount is an amount of a compound that ameliorates a symptom of osteoarthritis and/or prevents or reduces the rate of cartilage damage. The specific dose of a compound administered according to this invention will, of course, be determined by the particular circumstances surrounding the case including, for example, the compound administered, the route of administration, the state of being of the patient, and the severity of the pathological condition being treated.

The dose of a compound of this invention to be administered to a subject is rather widely variable and subject to the judgment of the attending physician. It should be noted that it may be necessary to adjust the dose of a compound when it is administered in the form of a salt, such as a laureate, the salt forming moiety of which has an appreciable molecular weight.

The following dosage amounts and other dosage amounts set forth elsewhere in this description and in the appendant claims are for an average human subject having a weight of about 65 kg to about 70 kg. The skilled practitioner will readily be able to determine the dosage amount required for a subject whose weight falls outside the 65 kg to 70 kg range, based upon the medical history of the subject. All doses set forth herein, and in the appendant claims, are daily doses of the free base form of the estrogen agonists/antagonists. Calculation of the dosage amount for other forms of the free base form such as salts or hydrates is easily accomplished by performing a simple ratio relative to the molecular weights of the species involved.

The general range of effective administration rates of an estrogen agonist/antagonist is from about 0.001 mg/day to about 200 mg/day. A preferred rate range is from about 0.010 mg/day to about 100 mg/day. Of course, it is often practical to administer the daily dose of compound in portions, at various hours of the day. However, in any given case, the amount of compound administered will depend on such factors as the potency of the specific estrogen agonist/antagonist, the solubility of the compound, the formulation used and the route of administration.

Methods of formulation are well known in the art and are disclosed, for example, in Remington's Pharmaceutical Sciences, Mack Publishing Company, Easton, Pa., 19th Edition (1995). Pharmaceutical compositions for use within the present invention can be in the form of sterile, non-pyrogenic liquid solutions or suspensions, coated capsules, suppositories, lyophilized powders, transdermal patches or other forms known in the art.

Capsules are prepared by mixing the compound with a suitable diluent and filling the proper amount of the mixture in capsules. The usual diluents include inert powdered substances such as starch of many different kinds, powdered cellulose, especially crystalline and microcrystalline cellulose, sugars such as fructose, mannitol and sucrose, grain flours and similar edible powders.

Tablets are prepared by direct compression, by wet granulation, or by dry granulation. Their formulations usually incorporate diluents, binders, lubricants and disintegrators as well as the compound. Typical diluents include, for example, various types of starch, lactose, mannitol, kaolin, calcium phosphate or sulfate, inorganic salts such as sodium chloride and powdered sugar. Powdered cellulose derivatives are also useful. Typical tablet binders are substances such as starch, gelatin and sugars such as lactose, fructose, glucose and the like. Natural and synthetic gums are also convenient, including acacia, alginates, methylcellulose, polyvinylpyrrolidine and the like. Polyethylene glycol, ethylcellulose and waxes can also serve as binders.

A lubricant may be necessary in a tablet formulation to prevent the tablet and punches from sticking in the die. The lubricant is chosen from such slippery solids as talc, magnesium and calcium stearate, stearic acid and hydrogenated vegetable oils.

Tablet disintegrators are substances that facilitate the disintegration of a tablet to release a compound when the tablet becomes wet. They include starches, clays, celluloses, algins and gums, more particularly, corn and potato starches, methylcellulose, agar, bentonite, wood cellulose, powdered natural sponge, cation-exchange resins, alginic acid, guar gum, citrus pulp and carboxymethylcellulose, for example, may be used as well as sodium lauryl sulfate.

Tablets are often coated with sugar as a flavorant and sealant, or with film-forming protecting agents to modify the dissolution properties of the tablet. The compounds may also be formulated as chewable tablets, by using large amounts of pleasant-tasting substances such as mannitol in the formulation, as is now well-established in the art.

When it is desired to administer a compound as a suppository, the typical bases may be used. Cocoa butter is a traditional suppository base, which may be modified by addition of waxes to raise its melting point slightly. Water-miscible suppository bases comprising, particularly, polyethylene glycols of various molecular weights are in wide use.

The effect of the compounds may be delayed or prolonged by proper formulation. For example, a slowly soluble pellet of the compound may be prepared and incorporated in a tablet or capsule. The technique may be improved by making pellets of several different dissolution rates and filling capsules with a mixture of the pellets. Tablets or capsules may be coated with a film which resists dissolution for a predictable period of time. Topical formulations may be designed to yield delayed and/or prolonged percutaneous absorption of a compound. Even the parenteral preparations may be made long-acting, by dissolving or suspending the compound in oily or emulsified vehicles which allow it to disperse only slowly in the serum.

The term “prodrug” means a compound that is transformed in vivo to yield a compound of the present invention. The transformation may occur by various mechanisms, such as through hydrolysis in blood. A discussion of the use of prodrugs is provided by T. Higuchi and W. Stella, “Pro-drugs as Novel Delivery Systems,” Vol. 14 of the A.C.S. Symposium Series, and in Bioreversible Carriers in Drug Design, ed. Edward B. Roche, American Pharmaceutical Association and Pergamon Press, 1987.

For example, if a compound of the present invention contains a carboxylic acid functional group, a prodrug can comprise an ester formed by the replacement of the hydrogen atom of the acid group with a group such as (C1-C8)alkyl, (C2-C12)alkanoyloxymethyl, 1-(alkanoyloxy)ethyl having from 4 to 9 carbon atoms, 1-methyl-1-(alkanoyloxy)-ethyl having from 5 to 10 carbon atoms, alkoxycarbonyloxymethyl having from 3 to 6 carbon atoms, 1-(alkoxycarbonyloxy)ethyl having from 4 to 7 carbon atoms, 1-methyl-1-(alkoxycarbonyloxy)ethyl having from 5 to 8 carbon atoms, N-(alkoxycarbonyl)aminomethyl having from 3 to 9 carbon atoms, 1-(N-(alkoxycarbonyl)amino)ethyl having from 4 to 10 carbon atoms, 3-phthalidyl, 4-crotonolactonyl, gamma-butyrolacton-4-yl, di-N,N-(C1-C2)alkylamino(C2-C3)alkyl (such as -dimethylaminoethyl), carbamoyl-(C1-C2)alkyl, N,N-di(C1-C2)alkylcarbamoyl-(C1-C2)alkyl and piperidino-, pyrrolidino- or morpholino(C2-C3)alkyl.

Similarly, if a compound of the present invention comprises an alcohol functional group, a prodrug can be formed by the replacement of the hydrogen atom of the alcohol group with a group such as (C1-C6)alkanoyloxymethyl, 1-((C1-C6)alkanoyloxy)ethyl, 1-methyl-1-((C1-C6)alkanoyloxy)ethyl, (C1-C6)alkoxycarbonyloxymethyl, N—(C1-C6)alkoxycarbonylaminomethyl, succinoyl, (C1-C6)alkanoyl, α-amino(C1-C4)alkanoyl, arylacyl and α-aminoacyl, or α-aminoacyl-α-aminoacyl, where each α-aminoacyl group is independently selected from the naturally occurring L-amino acids, P(O)(OH)2, —P(O)(O(C1-C6)alkyl)2 or glycosyl (the radical resulting from the removal of a hydroxyl group of the hemiacetal form of a carbohydrate).

If a compound of the present invention comprises an amine functional group, a prodrug can be formed by the replacement of a hydrogen atom in the amine group with a group such as RX-carbonyl, RXO-carbonyl, NRXRX′-carbonyl where RX and RX′ are each independently (C1-C10)alkyl, (C3-C7)cycloalkyl, benzyl, or RX-carbonyl is a natural α-aminoacyl or natural α-aminoacyl-natural α-aminoacyl, —C(OH)C(O)OYX wherein YX is H, (C1-C6)alkyl or benzyl), —C(OYX0)YX1 wherein YX0 is (C1-C4)alkyl and YX1 is (C1-C6)alkyl, carboxy(C1-C6)alkyl, amino(C1-C4)alkyl or mono-N— or di-N,N—(C1-C6)alkylaminoalkyl, —C(YX2)YX3 wherein YX2 is H or methyl and YX3 is mono-N— or di-N,N—(C1-C6)alkylamino, morpholino, piperidin-1-yl or pyrrolidin-1-yl.

Advantageously, the present invention also provides kits for use by a consumer to treat osteoarthritis. The kits comprise a) a pharmaceutical composition comprising an estrogen agonist/antagonist and a pharmaceutically acceptable carrier, vehicle or diluent; and b) instructions describing a method of using the pharmaceutical compositions to treat osteoarthritis. The instructions may also indicate that the kit is to treat osteoarthritis while substantially reducing the concomitant liability of adverse effects associated with estrogen administration.

A “kit” as used in the instant application includes a container for containing the pharmaceutical compositions and may also include divided containers such as a divided bottle or a divided foil packet. The container can be in any conventional shape or form as known in the art which is made of a pharmaceutically acceptable material, for example a paper or cardboard box, a glass or plastic bottle or jar, a re-sealable bag (for example, to hold a “refill” of tablets for placement into a different container), or a blister pack with individual doses for pressing out of the pack according to a therapeutic schedule. The container employed can depend on the exact dosage form involved, for example a conventional cardboard box would not generally be used to hold a liquid suspension. It is feasible that more than one container can be used together in a single package to market a single dosage form. For example, tablets may be contained in a bottle, which is in turn contained within a box.

An example of such a kit is a so-called blister pack. Blister packs are well known in the packaging industry and are being widely used for the packaging of pharmaceutical unit dosage forms (tablets, capsules, and the like). Blister packs generally consist of a sheet of relatively stiff material covered with a foil of a preferably transparent plastic material. During the packaging process, recesses are formed in the plastic foil. The recesses have the size and shape of individual tablets or capsules to be packed or may have the size and shape to accommodate multiple tablets and/or capsules to be packed. Next, the tablets or capsules are placed in the recesses accordingly and the sheet of relatively stiff material is sealed against the plastic foil at the face of the foil which is opposite from the direction in which the recesses were formed. As a result, the tablets or capsules are individually sealed or collectively sealed, as desired, in the recesses between the plastic foil and the sheet. Preferably the strength of the sheet is such that the tablets or capsules can be removed from the blister pack by manually applying pressure on the recesses whereby an opening is formed in the sheet at the place of the recess. The tablet or capsule can then be removed via said opening.

It may be desirable to provide a written memory aid, where the written memory aid is of the type containing information and/or instructions for the physician, pharmacist or patient, e.g., in the form of numbers next to the tablets or capsules whereby the numbers correspond with the days of the regimen which the tablets or capsules so specified should be ingested or a card which contains the same type of information. Another example of such a memory aid is a calendar printed on the card e.g., as follows “First Week, Monday, Tuesday,” . . . etc . . . “Second Week, Monday, Tuesday, . . . ” etc. Other variations of memory aids will be readily apparent. A “daily dose” can be a single tablet or capsule or several tablets or capsules to be taken on a given day.

Another specific embodiment of a kit is a dispenser designed to dispense the daily doses one at a time. Preferably, the dispenser is equipped with a memory-aid, so as to further facilitate compliance with the regimen. An example of such a memory-aid is a mechanical counter which indicates the number of daily doses that has been dispensed. Another example of such a memory-aid is a battery-powered micro-chip memory coupled with a liquid crystal readout, or audible reminder signal which, for example, reads out the date that the last daily dose has been taken and/or reminds one when the next dose is to be taken.

The kits of the present invention may also include, in addition to an estrogen agonist/antagonist, one or more additional pharmaceutically active compounds. Preferably, the additional compound is another estrogen agonist/antagonist or another compound useful to treat osteoarthritis. The additional compounds may be administered in the same dosage form as the estrogen agonist/antagonist or in different dosage forms. Likewise, the additional compounds can be administered at the same time as the estrogen agonist/antagonist or at different times. Compounds that are used to treat osteoarthritis and which can be used in combination with the estrogen agonists/antagonists of the present invention include acetominophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, ketoprofen, nabumetone, etodolac, salsalate, sulindac, diclofenac, tolmetin, flurbiprofen, piroxicam, fenoprofen, indomethacin, meclofenamate, oxaprozin, diflunisal, and ketorolac; and selective cyclooxygenase-2 (COX-2) inhibitors such as Celebrex® and Vioxx®. Because NSAIDs can have unwanted side effects such as ulcers, NSAIDs are sometimes administered with other compounds that ameliorate the side effects. Typical compounds that are used in combination with NSAIDs include proton pump inhibitors such as omeprazole; antacids such as sucralfate; and H2 blockers such as ranitidine, cimetidine, famotidine, and nizatidine. Thus, the combination aspect of the present invention comprises an estrogen agonist/antagonist, a NSAID and a compound that reduces a side effect of an NSAID. In addition, the combination aspect of the present invention also includes the coadministration of an estrogen agonist/antagonist and a COX-2 inhibitor. For example, (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol or an optical or geometric isomer thereof; a pharmaceutically acceptable salt, N-oxide, ester, quaternary ammonium salt, or a prodrug thereof can be administered with Celebrex® or Vioxx®. A preferred salt of (−)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-naphthalene-2-ol is the D-tartrate. The coadministration can be in the same dosage form or different dosage forms and at the same time or at different times. All possible modes and schedules of administration are contemplated. In addition, products derived from natural substances have been used to treat osteoarthritis. Examples include hyaluronic acid, glucosamine, chondroitin sulfate and capsaicin. Corticosteriods have also been used to treat osteoarthritis. All of the above compounds and others that can be used to treat osteoarthritis can be used in combination with the estrogen agonists/antagonists of the present invention. It is noted that the estrogen agonists/antagonists can be administered in the same dosage form (e.g., a tablet) or in different dosage forms. The compounds can be administered at the same time or at different times. All such variations are intended to be encompassed by the combination aspect of the present invention.

The effects of an estrogen agonist/antagonist on osteoarthritis can be determined by administering a compound to a patient having osteoarthritis for a time and observing the results. In addition, the effects of a compound on osteoarthritis can be measured using Type II collagen degradation products in the urine as a surrogate marker for cartilage degradation. The amount of Type II collagen degradation products in the urine can be compared before and after administration of the compound to determine if there is a change in Type II collagen degradation. Protocols for measuring the amount of Type II collagen degradation products in urine are known. One example is disclosed in U.S. Pat. No. 6,030,792, and another procedure is disclosed in U.S. patent application Ser. No. 09/504,262. Such tests can also be used to identify patients who are undergoing cartilage degradation, and who therefore, are at risk of developing osteoarthritis. These patients would benefit from the administration of a estrogen agonist/antagonist to help delay or prevent the onset of osteoarthritis.

All documents cited herein, including patents and patent applications, are hereby incorporated by reference.